Comment to: Implementing a protocol to prevent incisional hernia in high-risk patients—a mesh is a powerful tool

Hernia ◽  
2022 ◽  
Author(s):  
J. Li
Keyword(s):  
High Risk ◽  
Incisional Hernia ◽  
High Risk Patients ◽  
Risk Patients

scholarly journals Does pre-emptive onlay mesh reinforcement of midline laparotomies reduce incidence of incisional hernia in high–risk patients?

2019 ◽  
Vol 6 (7) ◽  
pp. 2300
Author(s):  
Hosam F. Abdelhameed ◽  
Samir A. Abdelmageed
Keyword(s):  
High Risk ◽  
Incisional Hernia ◽  
Chronic Wound ◽  
Midline Laparotomy ◽  
High Risk Patients ◽  
Wound Pain ◽  
Risk Patients ◽  
Onlay Mesh ◽  
Group 2 ◽  
Group 1

Background: One of the major morbidity after abdominal surgery is incisional hernia. In high risk patients its incidence reaches 11-20% despite various optimal closure techniques for midline laparotomy. Our aim is to evaluate the efficacy of onlay mesh placement in reducing the incidence of incisional hernia in those high risk patients.Methods: A total of 65 high risk patients suspected to develop post-operative incisional hernia underwent midline abdominal laparotomies. Patients were divided into two groups; group1 (30 patients) for whom the incision was closed by conventional method and group2 (35 patients) for whom the incision was closed with reinforcement by onlay polypropylene mesh. The primary end point was the occurrence of incisional hernia while the secondary end point was post-operative complications including subcutaneous seroma, chronic wound pain, and surgical site infection (SSI). Patients were followed up for two years.Results: The base line characteristics of the two groups were similar. The incidence of incisional hernia is significantly reduced 1/35 (2.8%) in group 2 while it was 6/30 (20%) in group 1. As regard seroma and chronic wound pain they increased in (group2) 6/35 (17.14%) and 5/35(14.28%) respectively compared to (group 1) which was 4/30 (13.33%) and 2/30 (6.66%). SSI occurred in 1/35 (2.85%) in group 2 and in 1/30 (3.33%) in group 1.Conclusions: Prophylactic onlay mesh reinforcement of the midline laparotomy for high risk patients can be used safely and markedly reduces the incidence of incisional hernia with little morbidity.

scholarly journals P106 PROPHYLACTIC MESH FOR PREVENTION OF INCISIONAL HERNIA IN HIGH-RISK PATIENTS: PVDF “VISIBLE” MESH BEHAVIOUR ON MRI

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Beatriz Carrasco Aguilera ◽  
Marina da Silva Torres ◽  
Jose Rodicio ◽  
Ana Fernández del Valle ◽  
Maria Moreno ◽  
...  
Keyword(s):  
High Risk ◽  
Incisional Hernia ◽  
Gastrointestinal Surgery ◽  
Safe Procedure ◽  
Prophylactic Mesh ◽  
Midline Laparotomy ◽  
Linea Alba ◽  
High Risk Patients ◽  
Risk Patients

Abstract Aim According to the guidelines, prophylactic mesh placement appears to be an effective, safe procedure in high-risk patients for the prevention of incisional hernia (IH) after midline laparotomy, without its use being standardized. Knowing its radiological behaviour can resolve doubts about its use. Material and Methods This was a prospective observational cohort study. The included patients needed to have more than one risk factor for IH (age> 60 years old, Body Mass Index > 30kg/m2, diabetes, chronic bronchopathy, heart disease, smoking, kidney disease, neoplasia, liver disease, immunosuppression or an emergency operation). Follow-up included 6-week and 12-month postoperative magnetic resonance imaging (MRI). If MRI was not performed, we used the follow-up computed tomography (CT). Results Between July 2016 and March 2021, 54 patients were enrolled in the study. Surgery was emergent in 14.8% of cases, clean-contaminated in 87% and upper gastrointestinal surgery in 51.9%. A total of 43 MRI and 3 CT at 6-week and 30 MRI and 2 CT at 12-month were carried out. The median of the mesh area were 150.7 vs 150,1cm2 respectively. 91% of cases had the mesh lined to the fascia at 12 months. The bridging in the linea alba was zero in 61% at 6-weeks and 24% at 12-month follow-up, mean 9 vs 19mm (p = 0.001). Conclusions The use of imaging tests to know the postoperative behaviour of a Polyvinylidenfluorid (PVDF) “visible” mesh shows us that there is no mesh contraction at one year or detachment of the fascia, however we observe a significant tendency in the separation of the linea alba.

scholarly journals O07 SHORT-TERM OUTCOMES OF A MULTICENTRE PROSPECTIVE STUDY USING A “VISIBLE” PVDF ONLAY MESH FOR THE PREVENTION OF MIDLINE INCISIONAL HERNIA

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Jose Rodicio ◽  
Carlos San Miguel ◽  
Javier López Monclús ◽  
Maria Moreno ◽  
Patricia López ◽  
...  
Keyword(s):  
High Risk ◽  
Incisional Hernia ◽  
Polyvinylidene Fluoride ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Short Term ◽  
High Risk Patients ◽  
Mesh Material ◽  
Risk Patients ◽  
Prophylactic Use

Abstract Aim Prophylactic meshes in high-risk patients prevent incisional hernias, although there are still some concerns about the best layer to place them in, the type of fixation, the mesh material, the significance of the level of contamination, and surgical complications. We aimed to provide answers to these questions and information about how the implanted material behaves based on its visibility under MRI. Material and Methods This is a prospective multicentre observational cohort study. Preliminary results from the first three months are presented. We included general surgical patients who had at least two risk factors for developing an incisional hernia. MRIs were performed six weeks after treatment. A polyvinylidene fluoride (PVDF) mesh loaded with iron particles was used in an onlay position. Results Between July 2016 and December 2020, 178 patients were enrolled in the study. Surgery was emergent in 30.3% of cases, contaminated in 10.7% and dirty in 11.8%. A total of 5.6% of cases had postoperative wound infections, with BMI being the only significant risk factor (OR = 1.14, 95% CI = 1.00-1.31, p = 0.048). The formation of a seroma was also associated with BMI (OR = 1.11, 95% CI = 1.02-1.21, p = 0.02). Conclusions The prophylactic use of onlay PVDF mesh in midline laparotomies in high-risk patients was safe and effective in the short term, regardless of the type of surgery or the level of contamination. MRI allowed us to understand how the mesh behaves during the early process of integration.

scholarly journals Repair of Complicated Multiple Incisional Hernia on One Patient: Erlangen InlayOnlay Mesh Repair Combined with Extended Spider-Suture Technique

2020 ◽  
pp. 1-4
Author(s):  
Resit Demir ◽  
Resit Demir
Keyword(s):  
High Risk ◽  
Incisional Hernia ◽  
Abdominal Wall ◽  
Mesh Repair ◽  
Surgical Techniques ◽  
Suture Technique ◽  
Sonographic Examination ◽  
High Risk Patients ◽  
Risk Patients ◽  
Upper Abdomen

Purpose: Surgical treatment of large ventral hernia after laparotomy is a challenge for surgeons. It becomes even more complicated if there is more than one hernia on the abdominal wall and patients have additional risk factors such as BMI> 30, severe CAD or lung problems. In the following work I would like to introduce you two patients who had exactly these constellations and who could be operated successfully by combining two surgical techniques. Methods: Two high-risk patients, first had a large median and one para median and the second had a median and in the left upper abdomen an incisional hernia. The median hernia was closed in both patients with a mesh according to the Erlangen-Inlay-Onlay Mesh Repair (EIOM) procedure. The lateral incisional hernias were closed with the so-called Extended Spider-Suture Technique (ESST). The patients were then followed up for two years. Results: Both patients were very satisfied after two years and would recommend the operation to others. The clinical and sonographic examination of the two patients showed no evidence of hernia recurrence. Conclusion: The combination of both surgical techniques EIOM and ESST showed that all types of abdominal wall hernias can be treated safely even in high-risk patients.

Does Prophylactic Biologic Mesh Placement Protect Against the Development of Incisional Hernia in High-risk Patients?

2011 ◽  
Vol 35 (7) ◽  
pp. 1651-1655 ◽  
Author(s):  
O. H. Llaguna ◽  
D. V. Avgerinos ◽  
P. Nagda ◽  
D. Elfant ◽  
I. M. Leitman ◽  
...  
Keyword(s):  
High Risk ◽  
Incisional Hernia ◽  
Biologic Mesh ◽  
Mesh Placement ◽  
High Risk Patients ◽  
Risk Patients
Sign in / Sign up

Export Citation Format

Share Document